Several research groups, including ours, have identified significant behavior problems (externalizing behaviors and deficits in arousal and attention) among prenatal cocaine-exposed children. In our distinctive, large (N=556, cocaine exposed=200) prospective cohort studied since before birth, prenatal cocaine was associated with adverse gender-influenced behavior including externalizing and attention problems at age 7 years, after control for covariates. Our preliminary data (DA016373, 6/1/03-5/31/07) confirm and amplify those age 7 behavior problems for these cocaine-exposed young teens (age 14), including a new association between prenatal cocaine exposure and teen initiation of cocaine use. This leads us to predict that such behavior problems will worsen as these teens approach adulthood. Our prenatal cocaine-exposed longitudinal cohort provides a unique opportunity to assess in late adolescents (age 18 years), high-risk behaviors, particularly drug use, sexual activity and delinquency, and the underlying mechanisms predicting these behaviors. Hence our Specific Aims. Aim 1: Evaluate the impact of prenatal cocaine exposure on high-risk late teen behavior (N=400; 175 cocaine exposed), specifically the initiation and progression of a) illicit drug and alcohol use; b) risky sexual behaviors leading to increased risk for HIV; and c) delinquency; Aim 2: Through a multi-method, interdisciplinary approach, document the mechanisms of increased sensation seeking (Hypothesis 2A) and altered responsiveness to emotionally charged situations (Hypothesis 2B) that underlie prenatal cocaine-related increases in high-risk late teen behaviors in Aim 1. Our overarching conceptual model describes the complexity and interrelatedness of these outcomes, mechanisms, and postpartum exposure variables, as well as moderators at each age and across development. Because the outcomes of interest are either known or likely to be influenced by several other factors, we will evaluate the potential moderating effects of gender and community/family environment variables (both vulnerability and protective), and evaluate outcomes with appropriate multivariate analytic strategies. The results of this study will help shape critical public health messages for future pregnancies while advancing the field toward intervention research to improve outcomes for those teens and young adults who have already been exposed to cocaine during fetal development. PUBLIC HEALTH RELEVANCE: Several research groups, including ours, have identified significant behavior problems (externalizing behaviors and deficits in arousal and attention) among prenatal cocaine-exposed children. Our preliminary age 14 data confirm problems identified at an age 7-assessment, including a new association between prenatal cocaine exposure and teen initiation of cocaine use, leading us to predict that such behavior problems will worsen as these teens approach adulthood. The results of this study will help shape critical public health messages for future pregnancies while advancing the field toward intervention research to improve outcomes for those teens and young adults who have already been exposed to cocaine during fetal development.